Comparison between endoscopic submucosal tunnel dissection and endoscopic submucosal dissection for superficial neoplasia at esophagogastric junction: a case-matched controlled study of a single center from China.

BACKGROUND: So far, little evidence is available for the comprehensive comparison of endoscopic submucosal tunnel dissection (ESTD) with endoscopic submucosal dissection (ESD) for the treatment of superficial neoplasia at esophagogastric junction (EGJ). METHODS: EGJ superficial neoplasia patients with ESTD treatment between January, 2021 and August, 2020 were retrospectively reviewed and individually matched at 1:1 ratio with those with ESD treatment according to lesion size, specimen area and lesion location, forming ESTD and ESD group, respectively. A sample size of 17 patients was collected for each group. Treatment outcomes including resection time, specimen area, and resection speed as well as occurrence of complications were evaluated. RESULTS: Compared with ESD group, ESTD group got shorter resection time (111.00 ± 11.70 min for ESD group vs. 71.59 ± 6.18 min for ESTD group, p = 0.008) and faster section speed (0.23 ± 0.03 cm2/min for ESD group vs. 0.37 ± 0.06 cm2/min for ESTD group, p = 0.012). No complication was found to occur in ESTD group, while 1 patient with MP damage and 1 with delayed bleeding was found in ESD group. CONCLUSION: For the treatment of EGJ superficial neoplasia, ESTD is a safer and more effective and reliable endoscopic technique compared with ESD.

The role of Fe-oxidizing bacteria (FeOB) and organic matters in As removal in the heavy-polluted arid soil.

The bio-remediation of As-polluted farmlands in the arid area is seldomly reported. This study aimed at understanding the impact of DOM, Fe-oxides, and FeOB biogeochemical processes on As remediation. The approaches used included: FeOB strain Pseudomonas flavescens LZU-3; Batch-experiment. Our results showed that all FeOB tested effectively immobilized As (>95%) during microbial mineralization; DOM play an important role in the reduction of Fe(III)(hydr)oxides and As(V); Less-crystallized ferrihydrite transform to more-crystallized goethite and secondary minerals; Under the reaction of FeOB and DOM, the As-Fe-OM ternary compound were formed, containing N, S, C and O functional group; The addition of OM can clearly reduce soil Eh, promoting dissolution of As in bound to iron oxides, co-precipitation of the amorphous iron oxide in Fe(III)-OM-FeOB, closely related to As in bound to insoluble organics and sulfides and mineral residues, which plays an important role in controlling the mobilization of As. This study provides controlling of As transportation and transformation in the As-DOM-Bio-Fe ternary system as As-remediation technology in the arid soil.

Hybrid endoscopic submucosal dissection: An alternative resection modality for large laterally spreading tumors in the cecum?

BACKGROUND: Endoscopic resection for large, laterally spreading tumors (LSTs) in the cecum is challenging. Here we report on the clinical outcomes of hybrid endoscopic submucosal dissection (ESD) in large cecal LSTs. METHODS: We retrospectively reviewed data from patients with cecal LSTs ≥ 2 cm who underwent ESD or hybrid ESD procedures between January of 2008 and June of 2019. We compared the baseline characteristics and clinical outcomes, including procedure time, the en bloc and complete resection rates, and adverse events. RESULTS: A total of 62 patients were enrolled in the study. There were 27 patients in the ESD group and 35 patients in the hybrid ESD group, respectively. Hybrid ESD was more used for lesions with submucosal fibrosis. No other significant differences were found in patient characteristics between the two groups. The hybrid ESD group had a significantly shorter procedure time compared with the ESD group (27.60 ± 17.21 vs. 52.63 ± 44.202 min, P = 0.001). The en bloc resection rate (77.1% vs. 81.5%, P = 0.677) and complete resection rate (71.4% vs. 81.5%, P = 0.359) of hybrid ESD were relatively lower than that of the ESD group in despite of no significant difference was found. The perforation and post-procedure bleeding rate (2.9% vs. 3.7%, P = 0.684) were similar between the two groups. One patient perforated during the ESD procedure, which was surgically treated. One patient in the hybrid ESD group experienced post-procedure bleeding, which was successfully treated with endoscopic hemostasis. Post-procedural fever and abdominal pain occurred in six patients in the ESD group and five patients in the hybrid ESD group. One patient in the ESD group experienced recurrence, which was endoscopically resected. CONCLUSION: The results of this study indicate that hybrid ESD may be an alternative resection strategy for large cecal LSTs with submucosal fibrosis.

The outcomes of modified endoscopic mucosal resection and endoscopic submucosal dissection for the treatment of rectal neuroendocrine tumors and the value of endoscopic morphology classification in endoscopic resection.

BACKGROUND: To compare the outcomes of modified endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs) and evaluate the value of endoscopic morphology classification in endoscopic resection (ER). METHODS: Patients with rectal NET diameters less than 2 cm who were treated between April 2007 and January 2019 were enrolled. The endoscopic morphology of rectal NETs was classified based on the endoscopic views. Patients who underwent ESD and m-EMR were compared. Baseline characteristics as well as en bloc resection, complete resection, the procedure time, adverse events and the risk factors associated with incomplete resection were analyzed. RESULTS: A total of 429 patients with 449 rectal NETs were enrolled for the classification of endoscopic morphology and were classified into four types (Ia, IIb, II, and III). There were 79 patients in the m-EMR group and 259 patients in the ESD group before matching. Propensity score matching created 77 pairs between the two groups that were well balanced. The mean procedure time was significantly shorter for m-EMR than for ESD (9.1 ± 4.4 min vs 16.0 ± 7.9 min, P = 0.000). The rates of en bloc resection (98.7% vs 100%; P = 1.000), complete resection (90.9% vs 93.5%, P = 0.548) and adverse events (2.6% vs 2.6%, P = 1.000) were similar between the two groups. Univariate and multivariate analyses showed that histopathological grade and endoscopic morphology were associated with incomplete resection. CONCLUSION: Both ESD and m-EMR are effective and safe for the treatment of rectal NETs. Endoscopic morphology should be considered along with histopathological grade for ER.

Vertical distribution of arsenic and bacterial communities in calcareous farmland amending by organic fertilizer and iron-oxidizing bacteria: Field experiment on concomitant remediation.

The migration and transformation mechanisms of arsenic (As) in soil environments necessitate an understanding of its influencing processes. Here, we investigate the subsurface biogeochemical transformation of As and iron (Fe) through amended in the top 20 cm with iron oxidizing bacteria (FeOB) and organic fertilizer (OF). Our comprehensive 400-day field study, conducted in a calcareous soil profile sectioned into 20 cm increments, involved analysis by sequential extraction and assessment of microbial properties. The results reveal that the introduction of additional OF increased the release ratio of As/Fe from the non-specific adsorption fraction (136.47 %) at the subsoil depth (40-60 cm), underscoring the importance of sampling at various depths and time points to accurately elucidate the form, instability, and migration of As within the profile. Examination of bacterial interaction networks indicated a disrupted initial niche in the bottom layer, resulting in a novel cooperative symbiosis. While the addition of FeOB did not lead to the dominance of specific bacterial species, it did enhance the relative abundance of As-tolerant Acidobacteria and Gemmatimonadetes in both surface (39.2 % and 38.76 %) and deeper soils (44.29 % and 23.73 %) compared to the control. Consequently, the amendment of FeOB in conjunction with OF facilitated the formation of poorly amorphous Fe (hydr)oxides in the soil, achieved through abiotic and biotic sequestration processes. Throughout the long-term remediation process, the migration coefficient of bioavailable As within the soil profile decreased, indicating that these practices did not exacerbate As mobilization. This study carries significant implications for enhancing biogeochemical cycling in As-contaminated Sierozem soils and exploring potential bioremediation strategies. ENVIRONMENTAL IMPLICATION: The long-term exposure of sewage irrigation has potential adverse effects on the local ecosystem, causing serious environmental problems. Microorganisms play a vital role in the migration and transformation of arsenic in calcareous soil in arid areas, which highlights the necessity of understanding its dynamics. The vertical distribution, microbial community and fate of arsenic in calcareous farmland soil profile in northwest China were studied through field experiments. The results of this work have certain significance for the remediation of arsenic-contaminated soil in arid areas, and provide new insights for the migration, transformation and remediation of arsenic in this kind of soil.

Nicotinamide adenine dinucleotide phosphate oxidase in pancreatic diseases: Mechanisms and future perspectives.

Pancreatitis and pancreatic cancer (PC) stand as the most worrisome ailments affecting the pancreas. Researchers have dedicated efforts to unraveling the mechanisms underlying these diseases, yet their true nature continues to elude their grasp. Within this realm, oxidative stress is often believed to play a causal and contributory role in the development of pancreatitis and PC. Excessive accumulation of reactive oxygen species (ROS) can cause oxidative stress, and the key enzyme responsible for inducing ROS production in cells is nicotinamide adenine dinucleotide phosphate hydrogen oxides (NOX). NOX contribute to pancreatic fibrosis and inflammation by generating ROS that injure acinar cells, activate pancreatic stellate cells, and mediate macrophage polarization. Excessive ROS production occurs during malignant transformation and pancreatic carcinogenesis, creating an oxidative microenvironment that can cause abnormal apoptosis, epithelial to mesenchymal transition and genomic instability. Therefore, understanding the role of NOX in pancreatic diseases contributes to a more in-depth exploration of the exact pathogenesis of these diseases. In this review, we aim to summarize the potential roles of NOX and its mechanism in pancreatic disorders, aiming to provide novel insights into understanding the mechanisms underlying these diseases.

Arsenic and cadmium simultaneous immobilization in arid calcareous soil amended with iron-oxidizing bacteria and organic fertilizer.

Immobilization stands as the most widely adopted remediation technology for addressing heavy metal(loid) contamination in soil. However, it is crucial to acknowledge that this process does not eliminate pollutants; instead, it confines them, potentially leaving room for future mobilization. Presently, our comprehension of the temporal variations in the efficacy of immobilization, particularly in the context of its applicability to arid farmland, remains severely limited. To address this knowledge gap, our research delves deep into the roles of iron-oxidizing bacteria (FeOB) and organic fertilizer (OF) in the simultaneous immobilization of arsenic (As) and cadmium (Cd) in soils. We conducted laboratory incubation and field experiments to investigate these phenomena. When OF was combined with FeOB, a noteworthy transformation of available As and Cd into stable species, such as the residual state and combinations with Fe-Mn/Al oxides, was observed. This transformation coincided with changes in soil properties, including pH, Eh, soluble Fe, and dissolved organic carbon (DOC). Furthermore, we observed synergistic effects between available As and Cd when treated with bacteria and OF individually. The stabilization efficiency of As and Cd, as determined by the Toxicity Characteristic Leaching Procedure, reached its highest values at 33.39 % and 24.67 %, respectively, after 120 days. Nevertheless, the formation of iron­calcium complexes was disrupted due to pH fluctuations. Hence, long-term monitoring and model development are essential to enhance our understanding of the remediation process. The application of organic fertilizer and the use of FeOB in calcareous soil hold promise for the restoration of polluted soil and the maintenance of soil health by mitigating the instability of heavy metals(loid).

Temporal distribution and accumulation pattern of cadmium and arsenic in the actual field calcareous soil-maize system, northwest China.

The contrasting chemical behaviors of two toxic elements, arsenic (As) and cadmium (Cd) in co-contamination calcareous soil and its absorption by crops have not been thoroughly explored, especially in the implementation of the measure of prohibiting the use of wastewater to irrigate farmland. We propose that the present environmental characteristics of ecologically fragile areas and appropriate restoration measures are critical determinant of soil remediation. In this study, the typical field farmland irrigated by industrial and domestic wastewater in the Chinese Loess Plateau for >50 years was selected. The results showed that after the sewage irrigation was stopped, the mean contents of Cd (7.09 mg/kg) and As (13.47 mg/kg) in the soil were still rising, which might be a potential input source. The average values of soil risk indices such as the potential ecological risk (PERI = 2394), pollution load index (PLI > 4 for 60 % of studied samples), and degree of contamination (Dc = 86.6) showed severe soil pollution in the study area. The decrease of soil pH, the loss of soil texture and calcium carbonate were found to be the reasons for the high chemical activity of Cd. The bioconcentration factors (< 0.2) and translocation factor (> 1.0) of Cd indicate that corn is an excluder plant and an ideal phytoremediation method. Thus, 20 % of studied samples were higher than maximum permitted levels of Cd in grain, indicating potential related health hazards. On the contrary, As was mainly adsorbed in calcareous soil, and its bioavailability was lower compared with Cd. The difference between DTPA extraction and sequential extraction may be due to the transformation of chemical forms, resulting in unstable fractions increased the bioavailability of toxic elements. Overall, the findings provide new insights for solutions to manage and repair farmlands under the post-wastewater irrigation period.

Enrichment and distribution characteristics of heavy metal(loid)s in native plants of abandoned farmlands in sewage irrigation area.

Soil samples and native plants were collected from abandoned farmlands with a long history of sewage irrigation along Dongdagou stream, Baiyin City. We investigated the concentrations of heavy metal(loid)s (HMMs) in soil-plant system to evaluate the accumulation and transportation ability of HMMs in native plants. Results indicated that soils in study area were severely polluted by Cd, Pb, and As. With the exception of Cd, the correlation between total HMM concentrations in soil and plant tissues was poor. Among all investigated plants, no one was close to the criteria for the HMM concentrations of hyperaccumulators. The concentrations of HMMs in most plants were reached the phytotoxic level and the abandoned farmlands could not be used as forages, which showed that native plants may possess resistance capabilities or high tolerance for As, Cu, Cd, Pb, and Zn. The FTIR (Fourier transform infrared spectrometer) results suggested that the detoxification of HMMs in plants may depend on the functional groups (-OH, C-H, C-O, and N-H) of some compounds. Bioaccumulation factor (BAF), bioconcentration factor (BCF), and biological transfer factor (BTF) were used to identify the accumulation and translocation characteristics of HMMs by native plants. S. glauca had the highest mean values of BTF for Cd (8.07) and Zn (4.75). C. virgata showed the highest mean BAFs for Cd (2.76) and Zn (9.43). P. harmala, A. tataricus, and A. anethifolia also presented high accumulation and translocation abilities for Cd and Zn. High HMMs (As, Cu, Cd, Pb, and Zn) accumulation in the aerial parts of plants may lead to increased accumulation of HMMs in the food chain; additional research is desperately required. This study demonstrated the HM enrichment characteristics of weeds and provided a basis for the management of abandoned farmlands.

Sources, transfers and the fate of heavy metals in soil-wheat systems: The case of lead (Pb)/zinc (Zn) smelting region.

Heavy metals (HMs) from smelters pose severe challenges to the environmental soil quality of surrounding farmlands, and threaten human health through the food chain. This study explored the environmental effects of smelting activities on farmland soil, and additionally assessed the enrichment, transfer and health risk of HMs in soil-wheat systems. Multiple characterization results were combined to demonstrate that HMs from smelter waste were transferred to the surrounding soil. It was determined that the enrichment of HMs in soil-wheat systems is mainly controlled by the total HM concentration and pH in soil. Furthermore, the priority pollutant in soil-wheat systems was found to be Cd, and Cd affected the transfer of Cu, Mn and Pb from soil to wheat roots. Interestingly, the -OH stretching, C-H stretching, N-H amide and C-O bending were involved in detoxifying HMs in wheat. The mean values of non-carcinogenic and carcinogenic risks by consuming wheat grain were 9.1, 1.4E-02 (adults) and 11.3, 3.3E-03 (children), respectively, indicating a noteworthy health risk. This study highlighted the critical issues arising from Pb/Zn smelting activities on agricultural soils. Notwithstanding, to ensure food security, the affected regions could opt to follow up on the type of crops grown.

Bioavailability, transfer, toxicological effects, and contamination assessment of arsenic and mercury in soil-corn systems.

Sewage irrigation has solved the shortage of agricultural water and increased the content of heavy metal(loid)s (HMs) in soil-crop systems, which harms human health via the food chain. In this study, 43 pairs of soil and corn samples (leaf, stem1, stem2, stem3, root, husk, grain, and corncob) were collected in the Dongdagou (DDG) and Xidagou (XDG) streams of Baiyin City. Fraction and transfer of As and Hg were investigated, and toxicological effects and contamination were assessed in soil-corn systems. The results showed that the mean values of As and Hg in soil were 33.79 mg/kg and 0.96 mg/kg, respectively, which exceeded the soil background values in Gansu Province. As and Hg are mainly dominated by the residual fraction. Total and bioavailability contributed significantly to As and Hg accumulation in corn, with root, stem3, and leaf accumulating more strongly. The results based on the bioavailability concentration soil-corn transfer factor indicated that As and Hg tended to accumulate more in the root, stem3, and leaf and less in grain, and further assessment of the human health effects of consuming contaminated cron is needed. Scanning electron microscope (SEM) and Fourier transform infrared (FTIR) results showed that As and Hg were not significantly toxic to corn parts, indicating morphology. As and Hg were bound to hydroxyl groups in the outer epidermal cell wall of the roots, thereby reducing upward translocation. The trinity assessment (TA) model results indicated that the most severe contamination was found in root and stem1. The TA provides a practical tool for soil-cron systems and helps develop management strategies to prevent ecological hazards.

Remediation of arsenic-contaminated calcareous agricultural soils by iron-oxidizing bacteria combined with organic fertilizer.

In arid soil with low-iron and high-calcium carbonate contents, the fate of arsenic (As) is mainly controlled by the contents of calcium and organic matter in the soil. However, there is still a lack of knowledge about their interaction and that effect on their absorption by maize. The purpose of this study was to explore the long-term immobilization and repair mechanism of in situ As-contaminated farmland. We designed three treatments: iron-oxidizing bacteria (FeOB), organic fertilizer, FeOB and organic fertilizer added in combination. After 140-day field farmland remediation trial, the results showed that the FeOB can effectively immobilize the water-soluble As (FS1) in soil, and the organic fertilizer promoted the remediation of FeOB. In addition, the content of As in maize grains was reduced after treatment by FeOB and organic fertilizer. The XRD and XPS analysis of the topsoil showed that the combined treatment of FeOB and organic fertilizer promoted the formation of calcium arsenate mineral with low solubility and high stability; As(III) would gradually transform into As(V). The biological iron (hydr)oxide can increase the contents of Fe and As in the rhizosphere and form iron plaques on the surface of the roots by SEM-EDS analysis of maize root. Collectively, these results clarify the main biogeochemical ways to control the fate of As in calcareous soils with low-iron and low-organic matter contents and provide a basis for in situ remediation of As.

The changes in the physicochemical properties of calcareous soils and the factors of arsenic (As) uptake by wheat were investigated after the cessation of effluent irrigation for nearly 20 years.

It is not known what the buffering capacity of soils and arsenic (As) enrichment by crops is for calcareous agricultural soils after the end of long-term effluent irrigation. In this study, changes in soil physicochemical properties and factors of influencing As uptake by wheat were investigated in agricultural soils where sewage irrigation had been ceased for nearly 20 years. The results showed that the content of CaCO3 and pH in soil increased compared to the period before the cessation of sewage irrigation, but remained below the soil background value. Furthermore, CaCO3 is by far the main buffering substance in agricultural soils and indirectly contributes to the increase in pH. The As concentration in the soil was 36.4 ± 34.8 mg/kg, which was 0.56-10.28 times and 0.28-5.18 times higher than the soil background and risk screening values, respectively, but showed a decreasing trend. pH and Fe dissolution were the main reasons for the lower As concentration in the soil. Total As in soil was a better predictor of As in wheat, and soil electrical conductivity (EC) and soil organic matter (SOM) promoted As uptake by wheat. The competitive uptake of As by dissolved Si was an important reason for the mismatch between As concentrations in soil and wheat. This study highlighted the key issues of As transport transformation in soil-wheat systems after cessation of effluent irrigation, using agricultural soils, and provided a reference for soil risk management in agricultural soils in mining areas.

Per-oral endoscopic myotomy is safe and effective for pediatric patients with achalasia: A long-term follow-up study.

BACKGROUND: Per-oral endoscopic myotomy (POEM) is emerging as a prefer treatment option for pediatric achalasia. However, data are limited on the long-term efficacy of POEM in children and adolescents with achalasia. AIM: To evaluate the safety and long-term efficacy of POEM for pediatric patients with achalasia and compare those outcomes with adult patients. METHODS: This retrospective cohort study was conducted in patients with achalasia who underwent POEM. Patients aged under 18 years were included in the pediatric group; patients aged between 18 to 65 years who underwent POEM in the same period were assigned to the control group. For investigation of long-term follow-up, the pediatric group were matched with patients from the control group in a 1:1 ratio. The procedure-related parameters, adverse events, clinical success, gastroesophageal reflux disease (GERD) after POEM, and quality of life (QoL) were evaluated. RESULTS: From January 2012 to March 2020, POEM was performed in 1025 patients aged under 65 years old (48 in the pediatric group, 1025 in the control group). No significant differences were observed in the occurrence of POEM complications between the two groups (14.6% vs 14.6%; P = 0.99). Among the 34 pediatric patients (70.8%) who underwent follow-up for 5.7 years (range 2.6-10.6 years), clinical success was achieved in 35 patients (35/36; 97.2%). No differences were observed in post-POEM GERD occurrence (17.6% vs 35.3%; P = 0.10). QoL was significantly improved in both groups after POEM. CONCLUSION: POEM is safe and effective for pediatric patients with achalasia. It can achieve significant symptoms relief and improve QoL.

Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection as a salvage option for recurrent achalasia.

BACKGROUND: For recurrent achalasia after initial peroral endoscopic myotomy (POEM) failure, repeat POEM (Re-POEM) has been reported as a treatment option. However, severe esophageal interlayer adhesions caused by previous procedures impede the successful establishment of a submucosal tunnel and lead to aborted Re-POEM procedures. Our team previously described POEM with simultaneous submucosal and muscle dissection (POEM-SSMD) as a feasible solution for achalasia with severe interlayer adhesions. AIM: To investigate the effectiveness and safety of Re-POEM with simultaneous submucosal and muscle dissection (Re-POEM-SSMD). METHODS: A total of 1049 patients with achalasia who underwent successful endoscopic myotomy at the Digestive Endoscopic Center of Chinese PLA General Hospital from December 2014 to May 2022 were reviewed. Patients with recurrent achalasia who experienced initial POEM clinical failure were retrospectively included in this study. The primary endpoint was retreatment clinical success, defined as an Eckardt score ≤ 3 during the postretreatment follow-up and no need for additional treatment. Procedure-related adverse events, changes in manometric lower esophageal sphincter (LES) pressure and reflux complications, as well as procedure-related parameters, were recorded. RESULTS: Sixteen patients underwent Re-POEM (9 patients) or Re-POEM-SSMD (7 patients) successfully at a median of 45.5 mo (range, 4-95 mo) after initial POEM. During a median follow-up period of 31 mo (range, 7-96 mo), clinical success (Eckardt score ≤ 3) was achieved in 8 (88.9%) and 6 (85.7%) patients after Re-POEM and Re-POEM-SSMD, respectively (P = 0.849). The median Eckardt score dropped from 4 (range, 3-8) at preretreatment to 1 (range, 0-5) at postretreatment in the Re-POEM group (P = 0.025) and from 5 (range, 2-8) to 2 (range, 0-4) in the Re-POEM-SSMD group (P < 0.001). The mean manometric LES pressure decreased from 23.78 ± 9.04 mmHg to 11.45 ± 5.37 mmHg after Re-POEM (P < 0.001) and from 26.80 ± 7.48 mmHg to 11.05 ± 4.38 mmHg after Re-POEM-SSMD (P < 0.001). No serious adverse events were recorded in both groups. CONCLUSION: In conclusion, Re-POEM-SSMD appears to be a safe and effective salvage therapy for recurrent achalasia with severe interlayer adhesions.

A modified exposed endoscopic full-thickness resection: Traction-assisted resection while defect closing.

OBJECTIVES: Exposed endoscopic full-thickness resection (Eo-EFTR) has proven effective and economical for patients with gastric submucosal tumors (SMTs), showing great prospects. However, the poor operative field of view, the risk of tumors falling into the peritoneal cavity, especially the difficulties in defect closure, have limited its widespread application. Herein, we described a modified traction-assisted Eo-EFTR technique aimed at simplifying both the dissection and defect closure procedures. METHODS: Nineteen patients who underwent the modified Eo-EFTR for gastric SMTs in the Chinese People's Liberation Army General Hospital were enrolled in the study. Following a 2/3 circumferential full-thickness incision, a clip with dental floss was anchored to the resected part of the tumor surface. With the dental floss traction, the gastric defect was reshaped into a V shape, which facilitated the deployment of clips to close the defect. The defect closure and tumor dissection procedures were then performed alternately. Patients' demographics, tumor characteristics, and therapeutic outcomes were evaluated retrospectively. RESULTS: All tumors had an R0 resection. The median procedure time was 43 min (range 28-89 min). No severe perioperative adverse events occurred. Two patients experienced transient fever, and three patients complained of mild abdominal pain on the first day after the operation. All patients recovered on the next day with conservative management. No residual lesion or recurrence was reported during the follow-up period of 30.1 months. CONCLUSION: The safety and practicability of the modified technique might allow for wide clinical applications of Eo-EFTR in gastric SMTs.

Plasma exosomal hsa_circ_0079439 as a novel biomarker for early detection of gastric cancer.

BACKGROUND: Due to the poor prognosis of gastric cancer (GC), early detection methods are urgently needed. Plasma exosomal circular RNAs (circRNAs) have been suggested as novel biomarkers for GC. AIM: To identify a novel biomarker for early detection of GC. METHODS: Healthy donors (HDs) and GC patients diagnosed by pathology were recruited. Nine GC patients and three HDs were selected for exosomal whole-transcriptome RNA sequencing. The expression profiles of circRNAs were analyzed by bioinformatics methods and validated by droplet digital polymerase chain reaction. The expression levels and area under receiver operating characteristic curve values of plasma exosomal circRNAs and standard serum biomarkers were used to compare their diagnostic efficiency. RESULTS: There were 303 participants, including 240 GC patients and 63 HDs, involved in the study. The expression levels of exosomal hsa_circ_0079439 were significantly higher in GC patients than in HDs (P < 0.0001). However, the levels of standard serum biomarkers were similar between the two groups. The area under the curve value of exosomal hsa_circ_0079439 was higher than those of standard biomarkers, including carcinoembryonic antigen, carbohydrate antigen (CA)19-9, CA72-4, alpha-fetoprotein, and CA125 (0.8595 vs 0.5862, 0.5660, 0.5360, 0.5082, and 0.5018, respectively). The expression levels of exosomal hsa_circ_0079439 were significantly decreased after treatment (P < 0.05). Moreover, the expression levels of exosomal hsa_circ_0079439 were obviously higher in early GC (EGC) patients than in HDs (P < 0.0001). CONCLUSION: Our results suggest that plasma exosomal hsa_circ_0079439 is upregulated in GC patients. Moreover, the levels of exosomal hsa_circ_0079439 could distinguish EGC and advanced GC patients from HDs. Therefore, plasma exosomal hsa_circ_0079439 might be a potential biomarker for the diagnosis of GC during both the early and late stages.

SGK3 overexpression correlates with a poor prognosis in endoscopically resected superficial esophageal squamous cell neoplasia: A long-term study.

BACKGROUND: The expression status of serum and glucocorticoid-induced protein kinase 3 (SGK3) in superficial esophageal squamous cell neoplasia (ESCN) remains unknown. AIM: To evaluate the SGK3 overexpression rate in ESCN and its influence on the prognosis and outcomes of patients with endoscopic resection. METHODS: A total of 92 patients who had undergone endoscopic resection for ESCN with more than 8 years of follow-up were enrolled. Immunohistochemistry was used to evaluate SGK3 expression. RESULTS: SGK3 was overexpressed in 55 (59.8%) patients with ESCN. SGK3 overexpression showed a significant correlation with death (P = 0.031). Overall survival and disease-free survival rates were higher in the normal SGK3 expression group than in the SGK3 overexpression group (P = 0.013 and P = 0.004, respectively). Cox regression analysis models demonstrated that SGK3 overexpression was an independent predictor of poor prognosis in ESCN patients (hazard ratio 4.729; 95% confidence interval: 1.042-21.458). CONCLUSION: SGK3 overexpression was detected in the majority of patients with endoscopically resected ESCN and was significantly associated with shortened survival. Thus, it might be a new prognostic factor for ESCN.

Linked color imaging vs Lugol chromoendoscopy for esophageal squamous cell cancer and precancerous lesion screening: A noninferiority study.

BACKGROUND: Lugol chromoendoscopy (LCE) has served as a standard screening technique in high-risk patients with esophageal cancer. Nevertheless, LCE is not suitable for general population screening given its side effects. Linked color imaging (LCI) is a novel image-enhanced endoscopic technique that can distinguish subtle diff-erences in mucosal color. AIM: To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions. METHODS: In this prospective study, we enrolled 543 patients who underwent white light imaging (WLI), LCI and LCE successively. We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions. Clinicopathological features and color analysis of lesions were assessed. RESULTS: In total, 43 patients (45 neoplastic lesions) were analyzed. Among them, 36 patients (38 neoplastic lesions) were diagnosed with LCI, and 39 patients (41 neoplastic lesions) were diagnosed with LCE. The sensitivity of LCI was similar to that of LCE (83.7% vs 90.7%, P = 0.520), whereas the specificity of LCI was greater than that of LCE (92.4% vs 87.0%, P = 0.007). The LCI procedure time in the esophageal examination was significantly shorter than that of LCE [42 (34, 50) s vs 160 (130, 189) s, P < 0.001]. The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI. However, the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer. CONCLUSION: LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions, and LCI represents a promising screening strategy for general populations.